• Medical Director - Florida

    Humana (Sacramento, CA)
    …community and help us put health first** The Medical Director relies on medical background and reviews health claims . The Medical Director work ... focus on collaborative business relationships, value based care, population health , or disease or care management. Medical ...population health , or disease or care management. Medical Directors support Humana values, and Humana's Bold Goal… more
    Humana (07/29/25)
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  • Medical Director - NorthEast Region

    Humana (Sacramento, CA)
    …community and help us put health first** The Medical Director relies on medical background and reviews health claims . The Medical Director work ... Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health more
    Humana (07/25/25)
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  • Sr. Professional Liability Medical

    Providence (CA)
    …we must empower them.** **Providence is calling a Sr. Professional Liability Medical Claims Manager who will:** **Investigate, evaluate, and manage professional, ... + Work with defense attorneys specializing in defense of medical negligence claims + Have direct responsibility...including a retirement 401(k) Savings Plan with employer matching, health care benefits ( medical , dental, vision), life… more
    Providence (08/28/25)
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  • Claims Research Specialist

    Dignity Health (Bakersfield, CA)
    …is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business ... **Responsibilities** The Claims Research Specialist will oversee and manage research...Administration, or related field **Overview** The purpose of Dignity Health Management Services Organization (Dignity Health MSO)… more
    Dignity Health (08/28/25)
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  • Senior Liability Claims Adjuster

    CVS Health (Sacramento, CA)
    …Qualifications** . 3+ years of experience handling complex druggist and professional medical malpractice claims with either a healthcare company, insurance ... At CVS Health , we're building a world of health...5+ years of experience handling complex druggist and professional medical malpractice claims with either a healthcare… more
    CVS Health (08/24/25)
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  • Medical Claims Examiner (Remote…

    TEKsystems (Fresno, CA)
    We are hiring Medical Claims Examiners! Must live within 65...or equivalent. + 2+ years of experience as a Health Claims Examiner or in a related role. ... 4:00PM PST Monday-Friday Overview Our client is seeking a Medical Claims Examiner to join their growing...employee and dependents) * Short and long-term disability * Health Spending Account (HSA) * Transportation benefits * Employee… more
    TEKsystems (08/26/25)
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  • Medical Biller - Healthcare Claims

    Guidehouse (San Marcos, CA)
    …**:** None **Clearance Required** **:** None **What You Will Do** **:** The ** Medical Biller** is expected to perform all areas of initial billing, secondary ... billing, and payer audit follow-up for government and non-government claims . Must work with other departments to facilitate the...any and all related job duties as assigned. **_The medical biller will be working a Hybrid schedule based… more
    Guidehouse (08/24/25)
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  • Medical Director - Medicare Grievances…

    Humana (Sacramento, CA)
    …us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate ... focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience + Working with health more
    Humana (08/08/25)
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  • Medical Claims Processor - Remote

    Cognizant (Sacramento, CA)
    …High School Diploma or equivalent is required + A minimum of 1 years of medical claims processing is required + Facets experience is highly preferred + Knowledge ... Claims Processors to join our growing team. The ** Medical ** ** Claims Processor** is responsible for the...Now and Inquiry resolution, and any basic questions regarding health coverage as stated in the Plan Document. **Role… more
    Cognizant (08/26/25)
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  • Vice President of Health Plan Operations…

    Prime Healthcare (Ontario, CA)
    …Responsibilities This position requires relocating to Ontario, California. TheVice President of Health Plan Operations and Claims is responsible for the ... technology and data to improve the quality and minimize process cost of Claims for all Prime Healthcare's self-insured Employee Health Plans. Through in-depth… more
    Prime Healthcare (08/11/25)
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